A&A practice
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Pulmonary hypertension in children is commonly caused by underlying cardiac and pulmonary disease. Within the past 10 years, scurvy has been identified as a cause for pulmonary hypertension. ⋯ Cardiac catheterization revealed pulmonary hypertension, which dramatically improved with administration of vitamin C. Anesthesiologists should be aware that scurvy is more common than previously thought, even in developed countries and can cause unexpected circulatory collapse from pulmonary hypertensive crisis.
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Complex regional pain syndrome (CRPS) is a severely disabling condition that typically develops after an inciting traumatic event. Ketamine infusion in subanesthetic dose provides sustained analgesia in selected cases of CRPS. ⋯ Here, we report a case of a CRPS patient on intrathecal baclofen pump developing syndrome of inappropriate antidiuretic hormone release (SIADH) during ketamine infusion. Prophylactic treatment with intravenous loop diuretics was successful in preventing the development of SIADH during ketamine infusion during subsequent infusions in this case.
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Review Case Reports
Role of Ultrasound in Emergency Front of Neck Access: A Case Report and Review of Literature.
Emergency front of neck access (eFONA) is a lifesaving procedure in a cannot intubate cannot oxygenate (CICO) situation. We report a case of a patient who presented to the emergency department (ED) in extremis with a difficult airway. ⋯ EFONA was established with the use of rapid ultrasound imaging and using the scalpel-bougie-tube technique. We present a review of literature relating to the use of ultrasound during emergency airway management.
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Case Reports
Painful Inguinal Angiomyomatous Hamartoma Responsive to Conservative Pain Management: A Case Report.
Angiomyomatous hamartoma (AMH) is a rare and benign mixed-tissue tumor of the lymphatic system. The majority of AMH tumors are removed surgically for cosmetic reasons or during workup of lymphadenopathy. ⋯ Here, we report a unique case of inguinal AMH recurring after surgical excision and causing a painful compression neuropathy. Our report also describes the patient's successful but transient response to nonsurgical pain management.
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We introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. ⋯ Postoperatively, his pain was well controlled, and narcotic requirements were decreased. Our case report demonstrates that for patients undergoing posterior spine surgery, intraoperative placement of bilateral paravertebral catheters can be used to help manage postoperative pain.